Stanford sets new policy for med students

…Stanford announced last month it would become the first U.S. university to require new medical students to pick “scholarly concentrations” — similar in spirit to undergraduate majors –…

apparently missing the point that medical school is a graduate program, with well -defined goals, and a fairly well-defined way of getting smart but untrained kids to become educated, trained doctors.

Attracting specialized, career-focused students is one reason Stanford University Medical Center overhauled its curriculum and required students to pick a concentration by the end of their first year. Officials say the policy puts Stanford at the forefront of medical education.

Sometimes, being at the forefront means the train hits you first. I read this to mean that they weren’t attracting enough pale, lab-rat masochists, but that’s just me.

…”Students in medical school turn into cookie cutters, all learning the same, huge amount of data, and by the end the idealists are gone,” said Dr. Julie Parsonnet, Stanford’s senior associate dean for medical education. “We’re saying, ‘We know you’re all different from each other and you have individual reasons for going to school.’ We want to foster that passion and still produce great doctors.”

How better to foster idealism than by tacking on 200 hours of “scholarly concentration”. Also, exactly what part of that huge amount of data will you be cutting out to add in a scholarly concentration? The part about my ankle, or my MI? A lot of idealism meets reality in med school; it’s a feature, not a bug.

…Stanford’s program came after an 18-month curriculum review, when officials discovered 70 percent of students were taking five or more years to get through the four-year program.

They had to do a study to find out their students weren’t graduating on time? That’s educational malpractice.

Most spent an extra year on independent projects.

Hmmm. Students figured out a way to make getting a job take another year. Surprise! Want another answer? Spend another year, get the PhD, then you have an accomplishment, not just an extra year of student loans.

…Stanford’s newest class of 87 students must devote at least 200 hours to a project in their concentration. Officials added three weeks to the fall quarter and asked professors to spend less time in the classroom each week and more time supervising students in interactions with patients.

200 hours over 3 weeks is only 67 hrs/wk, which is a cake walk for most medical students, but there’s no way it’s put together like that. It’s too easy that way.

…”Ultimately, I think it puts us in a better career position,” (an un-named by me student) said of the curriculum change.

Ummm, no. Were I a residency director I’d be unlikely to be super-impressed that you spent 200 hours in a scholarly concentration. Oh, it’ll give you something to chat about in interviews (you’ll bring it up, trust me), but the residency director needs residents who also see patients, as well as max out board scores, so you’re not going to do so well.

And Stanford now officially shouldn’t get to complain about the high student indebtedness, after requiring more specialization of med students. Aso, they have lost any pretense to lecture about the decline of generalists, as they encourage specialization from the outset.

Update: Idealists respond. I agree that Medicine is changing, and all the med school idealists in the world aren’t going to fix it. Finish school, join us, and then join the ?whither the AMA? debate (heh).

Comments

“Students in medical school turn into cookie cutters, all learning the same, huge amount of data, and by the end the idealists are gone.”

Call me simple, but I don’t particularly give a rat’s patootie if my physician is an “idealist” — I want my physician to be smart and know as many *facts* about medicine as possible. And I want my physician to be reasonably well-rested, dammit!

Look, “bedside manner” is fine & dandy — and I can appreciate a “well-rounded” physician – but not if it comes at the expense of either over-over-burdening the doc’s brain with information that he/she doesn’t necessarily need to know except to graduate, or creating a burned-out doc just a few years into his/her career.

In response to Gross Anatomy. Oh, to be young and idealistic! I think we were all there at one point in our career. The “I just want to be a doctor so I can save the world” attitude will fade in a few years, trust me on this one. After four years of medical school (or five or six in Stanfords case) and 3 to 7(or 8 or whatever) years of residency you hopefully become more of realist and see that medicine is less idealistic than you can imagine. The reality is that you will be expected to see more patients than you feel comfortable seeing, most will continue to go on with their smoking, eating, drinking self abuse, some will blame their failure to improve on your poor doctoring skill, about half won’t pay you for your time (cigarettes and beer are expensive you know and there is only so much money) and then they will come back and sue you because they got worse instead of better, despite your best efforts. That is reality! Do I sound like a pessimist, no- a realist. Do I still love being a doctor, yes- I look forward to going to work each day and would not trade it for anything. But until you have experience something you are not qualified to comment on it. Having just learned how to do a physical exam does not make a doctor. I would be curious to your response after you have finished med school and residency(about ten years from now)

Medical school is a PROFESSIONAL school. (Sorry about the caps) You go to medical school to learn a profession. If you want to do some extra time and get your PhD., go ahead. If they wanted to preseve “idealism” they should say, “Hey if you want to do this extra study, go right ahead, we will help you any way we can,” but they shouldn’t make it a requirement. This seems like the “manditory” community-service “volunteer” work that many schools have initiated. Are they trying to transform their medical school into another, more expensive, liberal arts college? Seems like it to me.

This new policy is not only provocative and risky, as Dr. Ray Curry of Northwestern was quoted as saying, but also a perfect recipe for disaster. As the Stanford students were saying, they are already drowning in a flood of information to be saddled with additional requirements that, no matter how you cut it, don’t make much sense early in their careers.

When it is known that 70% of Stanford students take five or more more years to complete a four-year curriculum, the obvious solution is not to pile on more hours, but to cut the fat off and modify the curriculum so that students can finish on time. There may be some students who want to get dual degrees, but why not require them to finish their Masters’ and PhD degrees before embraking on medical school?

The four years of medical education that the vast majority of us went through should be time spent in getting the basics for an M.D. degree. The last year of medical training, when students are expected to have been exposed to all the clinical disciplines, is the best time to decide on choosing specialties, or “scholarly concentrations,” as Stanford is now using for its new buzzword. It has worked for years and I see no reason why it should be changed.The first year in medical school is the worst time possible to choose any scholarly pursuit, when students are just getting introduced to the basics of their medical education.

If Stanford is worried about bringing back passion to its medical students, it must think of other ways to do so. It is probably true that most medical students learn the same mass of data while in medical school, but what is wrong with that? We all went through the same process, and nothing was ever said about overcompetitive and high-achieving students lacking the passion to learn during those four years. That passion, or what little remains of Stanford students, is going to be snuffed out with this planned “risky” venture.

Finally, at a time when it is imperative that we train more primary care practitioners, this new policy is certain to steer students away from the broad medical disciplines. Unless Stanford has changed its focus to training its students towards research careers and narrow-based disciplines, I find no justification to pursue a policy that potentially will be doomed to failure.

It appears to me we ought not to be changing things when there is no compelling need to change them.

Darren–I’m concerned about my lack of idealism, too. It’s one of the reasons I’m blogging. I think it’ll both help me maintain some of it, and also shed some interesting light on my changing thought patterns as I learn more and more about medicine.

I just think medicine’s gotten to a really dangerous place, where med students who graduated last year cared more about having a good lifestyle and time off than money and prestige. To me that says that the profession is becoming less enjoyable.

“med students who graduated last year cared more about having a good lifestyle and time off than money and prestige. To me that says that the profession is becoming less enjoyable”

I am of the opinion that a physician who values a high quality of life over merely getting rich and demogoguery is exactly what we need. It was the physicians of decades past that used their power and position to attain more money and prestige that led the dehumanization of patients. I think it is great that docs are not looking at a patient as a cash cow, but approach them as a human being that they are the steward of.

True, the profession is becoming less enjoyable, but from what I have heard from physicians, that is due to the lawsuit abuse, overregulation and insurance paperwork that is diverting more and more energy from patient care. If you want to make the profession more enjoyable, then the way to go about it, is to give patients and doctors more control, and cut out the government and insurance companies from interfering.

Trackbacks

Just thought it was pretty damn cool that my classmate Dora made CNN and the AP about our new curriculum. I feel kinda bad, I have no big crazy research interests like her. Just hope I can make some sort…

Reading about Stanford’s plan to add a 200 hour “minor” in a particular field to their medical school curriculum. GruntDoc says this and Graham says this, while Doc Shazam feels like this. Hmm. I don’t know. Seems the most useful